‘Psychopathy’ (also referred to as sociopathy) is a psychological term describing personality traits that often, but not always, lead to criminal behaviour. It is characterised by an inability to feel guilt or remorse, gratification from criminal behaviour, the inability to make realistic long term plans, superficial charm, ‘impoverished emotions’ and a lack of long-term relationships. It is thought that roughly 1% of the population can be described as being psychopathic. However, due to a lack of scientific agreement on its criteria, some critics have postulated that it is ‘clinically useless’. Despite this, measures of psychopathy are widely used by forensic psychologists and others and there is a wealth of empirical evidence supporting its validity. This essay will attempt to describe the term as it is currently understood and critically evaluate its usefulness in assessing interpersonal behaviour in offenders.
The term ‘psychopathy’ has been recognised since the early 1800s and was once described by Pinel (1745-1826) as ‘insanity without delirium’ (Weissmann, 2008). An early modern description was provided by Hervey Cleckley in his book ‘The Mask of Sanity’ (1982 (originally published in 1941)). Here he described psychopaths as distinct from others with mental disorders (e.g. schizophrenia) due to their ability to project an ‘ordinary’ or even charming demeanour. Despite this unremarkable exterior, and a lack of symptoms such as hallucinations, Cleckley argued that the inability to empathise with others justified the need for psychopathy as a class of disorder.
In 1968 the condition (or an approximation) earned a place in the second revision of the American Psychiatric Association’s ‘Diagnostic and Statistical Manual of Mental Disorders’ (the DSM-II), though it was referred to as ‘antisocial personality’ and was described with vague criteria – a problem that existed in psychopathy research at the time. For the DSM-III then this was revised and subject to more distinct criteria that provided more detailed guidelines for diagnosis. This new method had increased reliability and was maintained for the DSM-IV. Critics however argue that the more rigid criteria saw a loss of validity. These criteria (now under the heading ‘Antisocial Personality Disorder’ or ‘ADP’) were based solely on behavioural tendencies, such as theft or failure to pay bills, but neglected psychological factors such as the inability to feel guilt.
Today psychopathy is most commonly operationalised using ‘The Psychopathy Checklist-Revised’ (PLC-R), a twenty item diagnostic tool that measures psychopathy and anti-social tendencies. In total there are 20 items: Glibness/Superficial Charm, Grandiose Sense of Self-Worth, Need for Stimulation/Proneness to Boredom, Pathological Lying, Conning/Manipulative, Lack of Remorse or Guilt, Shallow Affect, Callous/Lack of Empathy, Parasitic Lifestyle, Poor Behavioural Controls, Promiscuous Sexual Behaviour, Early Behavioural Problems, Lack of Realistic Long-Term Goals, Impulsivity, Irresponsibility, Failure to Accept Responsibility for Own Actions, Many Short-Term Marital Relationships, Juvenile Delinquency, Revocation of Conditional Release and Criminal Versatility. These items can be loaded onto two factors: ‘Personality’ and ‘Case History’. However items that do not load onto these factors are Promiscuous Sexual Behaviour, Criminal Versatility and Many Short-Term Marital Relationships. A further distinction of ‘primary’ and ‘secondary’ psychopathy can be made (Newman et al., 2005), with primary cases displaying mostly items from factor one and vice versa. Apart from the statistical support detailed below, another strength of the PLC-R is that it scores on a scale enabling psychopathy to be considered a dimensional disorder; a high score on the PLC-R might suggest a psychopathic personality but it is also possible to show ‘mild’ psychopathy.
Psychopathy is an effective indicator of various behaviours, for example a psychopath is three times more likely to re-offend than non-psychopaths and four times as likely when this involves violent offences. Many studies have found psychopathy and PCL-R scores to correlate with or be predictive of certain behaviours. For example one study found that inmates with high PCL scores were more likely to have been convicted for a violent crime than those with low scores (Hare & McPherson, 1984). A separate study by Wong (1984) compared psychopaths with non-psychopaths (as defined by their PCL scores) and found several interesting statistics including that psychopaths committed more than twice the amount of offenses per-year (when free), almost nine times as many institutional offences and that they generally committed their first crime at an earlier age. Serin (1991) found psychopaths were over twice as likely to have used weapons or instruments in an aggressive manner. When on Parole PCL-R scores were used to successfully predict who would fail by violating conditions of release (Hart et al., 1988; Serin et al., 1990). PCL-R scores also predict violent behaviour, and in some studies have been found to be more effective in this capacity than criminal history or demographic data (Serin et al., 1990; Harris et al., 1991).
With this strong evidence base, Psychopathy and PCL-R scores prove themselves to be invaluable tools for assessing and predicting the interpersonal behaviour of offenders. Indeed, Salekin et al. (1996) described the tool as an ‘unparalleled’ in risk assessment for evaluating the potential of violent (and non-violent) relapse. The PCL-R has been demonstrated to be effective regardless of gender though there are gender differences for certain items (Grann, 2000). It has also been shown to be largely applicable across cultures (Hildebrand, 2004; Sullivan et al., 2006). All this suggests that it is highly useful as a measure of assessing interpersonal behaviour in criminals.
The PCL-R correlates with both ADP and with the similar ‘Dissocial Personality Disorder’ (DPD) described in the International Statistical Classification of Diseases and Related Health Problems (ICD) published by the World Health Organization, though these correlations are not perfect. One study found that 50-80% of prisoners in England and Wales met the criteria for dissocial personality disorder, while only 15% met the criteria as measured by the PCL-R. For this reason it has been suggested that it is not useful in diagnosing dissocial or antisocial personality disorders (Ogloff, 2006).
The American Psychiatric Association and World Health Organisations in fact shun the ‘subjective’ qualities of psychopathy such as ‘remorse’ in favour of the observable behaviours in ADP. For these reasons, both dismiss the terms psychopathy and sociopathy as ‘obsolete’ and indistinguishable from antisocial/dissocial personality disorders respectively. This is the stance taken in both the DSM-IV-TR and ICD-10 (their latest iterations). Indeed, while both ‘psychopathy’ and ‘antisocial personality disorder’ have found their way into popular discourse, there is not wide-spread understanding regarding any distinction between the two. Hare (1996) however, argues the need for psychopathy as a separate term believing that the criteria for ADP are easily met by ‘the majority of criminals’. He argues further that the small percentage of criminals diagnosed with psychopathy as well as ADP are those who commit the more serious and violent crimes (Hare, 1993).
However, subjectivity in scoring the PCL-R has been shown to be an issue; in one study, Boccaccini et al (2008) discovered that across a sample of 22 offenders evaluated using the PCL-R evaluator agreement was low on several occasions. A similar study by Roberts et al (2002) assessed scores given by three evaluators in Wisconsin and found that one of the three consistently assigned significantly lower scores. Both these studies shed doubt on the reliability of the PCL-R as a tool for assessing behaviour.
Additionally, the PCL-R has been demonstrated to be ineffective under certain conditions and for certain cases. One study using a sample of 60 offenders with intellectual disability in a high security found that the PCL-R failed to predict aggressive behaviour, presumably due to the intellectual disabilities of the criminals. This is a concern as a large proportion of criminals are likely to suffer from intellectual disability. Meanwhile, two other more ‘clinical’ diagnostic tools, the Historical Clinical Risk-20 (HCR-20) and the Emotional Problem Scales’ Behaviour Ratings Scale were found to be successful in predicting aggression. There is also some evidence suggesting the PCL-R may be less useful for psychopathic offenders over the age of 40 who have been shown to commit fewer non-violent offenses as they age (Hare et al, 1988).
Here doubt has been shed on the reliability (and validity) of psychopathy and PCL-R score. The danger is that a term such as ‘Psychopathy’ or indeed any ‘label’, if not accurate or reliable, can lead to discrimination and bias on the part of researchers. This is particularly important as not all ‘psychopaths’ will necessarily commit crimes. There exist cases of individuals who would be considered psychopaths according to their PCL-R scores who nevertheless lead ordinary lives, often in positions of power and responsibility (Mahmut et al., 2008) (of course there remains the possibility that these high-functioning psychopaths simply avoided getting caught…). Courts often offer PCL-R scores as testimony when considering the potential for future violence (Walsh & Walsh, 2006) which, if the measure is inaccurate, could lead to the incarceration of innocent suspects, or the extended detainment of criminals who no-longer pose a threat to society. It is possible that an individual’s fate could be based on a scorer’s subjective idea of what constitutes abstract concepts such as morality, conscious and guilt. This clearly is not a desirable scenario.
Simply being labelled a ‘psychopath’ could also have implications for the psychopath in question and for their families. There are a lot of connotations associated with the term ‘psychopath’ and to the layperson it may denote an incurably ‘damaged’ individual, a belief perpetuated by a media fascinated with the criminally insane. It is easy to imagine that this might have detrimental effects on someone who is branded as such and it is possible it could potentially act as a self-fulfilling prophecy. There is also the risk that assessors may find it ‘convenient’ to label patients as psychopaths as a way of distancing their behaviour from ‘normal’ civilians. Professionals dealing with an individual diagnosed with psychopathy (and possibly juries) may also be disproportionately affected by a term that is so dehumanising (Edens et al., 2001 etc). In a way then the word itself could be considered un-useful and may be better served by a newer synonym.
Despite strong empirical support then, psychopathy as a term and the PCL-R itself are not without their criticisms. While these criticisms are important considerations, they do not detract from the empirical data discussed earlier; they instead warn that such evaluation should be made with caution and suggest it could be beneficial to have scores evaluated by more than one professional. While ‘ADP’ may be more reliable a measure, this author argues that this is a case for using a combination of both measures rather than eliminating one with such high validity and predictive value. While psychopathy is effective as a measure for assessing aggression in itself, it is clear that it could be more reliable when used alongside other tools.
Taken purely as a measure for assessing the interpersonal behaviour of offenders, psychopathy and the PCL-R have been shown to be highly useful over the course of many studies. It is perhaps the most well-established tool for the assessment of potential aggression (Archer et al., 2006) and this alone is an indication of its usefulness. It is imperative however that due care is taken when applying such a term.
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